Cerebral Palsy

Cerebral palsy is a term used to describe a group of disorders which affect movement and posture.

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Different parts of the brain control the movement of every muscle of the body. In cerebral palsy, there is damage to, or lack of development in part of the brain (which occurs within the first two years of life).

Symptoms of CP can be very different in every child. Children with cerebral palsy may have problems with:

Motor skills

Muscle weakness

Muscle tone (stiffness or abnormally loose)

Balance

Awkwardness

Slowness

Reflexes

Learning disabilities

Speech

These problems can range from mild to severe. In mild cerebral palsy, the child may be slightly clumsy in one arm or leg, and the problem may be barely noticeable. In severe cerebral palsy, the child may have a lot of difficulties in performing everyday tasks and movements.

Types of cerebral palsy

There are several different types of cerebral palsy. One way of classifying cerebral palsy is according to the type of movement disorder.

Spastic cerebral palsy: This is a common type of cerebral palsy. Spasticity means stiffness or tightness of muscles. The muscles are stiff because the messages to the muscles are relayed incorrectly from the damaged parts of the brain.

Dyskinetic cerebral palsy: This refers to the type of cerebral palsy with abnormal involuntary movements. It is divided into two types of movement problems, called dystonia and athetosis.

Dystonia – this is the term used for sustained or intermittent muscle contractions that frequently cause twisting or repetitive movements, or abnormal postures.

Athetosis – this is the word used for the uncontrolled extra movements that occur particularly in the arms, hands and feet, and around the mouth. The lack of control is often most noticeable when the child starts to move – for example, when the child attempts to grasp a toy or a spoon. In addition, children with athetoid cerebral palsy often feel floppy when carried.

Ataxic cerebral palsy:This is the least common type of cerebral palsy. Ataxic (or ataxia) is the word used for unsteady shaky movements or tremor. Movements are uncoordinated. Children with ataxia also have problems with balance.

Mixed types: Many children do not have just one type, but a mixture of several of these movement patterns.

Some of these concepts are difficult to understand. Please discuss them further with your therapist or doctor.

Effects on the body

The parts of the body affected by cerebral palsy varies greatly from one child to another. Certain words are used to describe the parts affected:

Hemiplegia – the leg and arm on one side of the body are affected (also described as hemiparesis).

Diplegia – both legs are predominantly affected. Children with diplegia usually also have some difficulties with their arm and hand movements.

Quadriplegia – both arms and both legs and the trunk are affected (also described as quadriparesis). The muscles of the face, mouth, and throat can also be involved.

The movement problem

The Gross Motor Function Classification System (GMFCS) is used to describe the range of abilities in gross motor function seen in children with cerebral palsy.

It describes five levels of motor function, with an emphasis on abilities and limitations in the areas of sitting, standing, and walking.

Children with GMFCS levels I and II walk independently

Children with GMFCS level III require a hand-held mobility aid such as crutches or a walker and may use a wheelchair for distances.

Children with GMFCS levels IV and V have more limitations in self-mobility and require a wheelchair.

GMFCS level can be accurately assessed from the time a child is two years of age.

Knowing a child’s GMFCS level can help the orthopaedic team predict the likelihood a child will have certain orthopedic problems as they grow.

Gross Motor Function Classification System between 6th and 12th birthday: descriptors and illustrations. (Descriptions are available for other age groups) — Illustrations copyright ? Kerr Graham, Bill Reid, and Adrienne Harvey, The Royal Children’s Hospital, Melbourne

Will my child's condition worsen?

No, the damage done to the brain does not become worse. However, as your child grows, it may seem that your child’s condition is changing or becoming worse. It may seem this way for a number of reasons.

The bones in children with cerebral palsy grow more quickly than the muscles. Muscles are stimulated to grow in length by moving and being stretched. This normally occurs throughout the day during a child’s activities and play time. In children with cerebral palsy, decreased control of muscles and increased muscle stiffness prevent muscles from moving through their full range of motion as easily or as often as other children. Because the bones grow faster than the muscles, the muscles become tight. This is especially true during growth spurts. A problem such as toe walking may become more apparent as the muscles in the heel cord become increasingly tight.

As children grow, their bones develop and change as they begin to use their muscles to move, particularly with standing and walking. This is called bone remodeling. Because children with cerebral palsy have decreased control of their muscles, have stiffness in their muscles, and/or are delayed in their independent mobility, bone development may not occur as expected. In addition, when bones do not develop as expected, the forces going through a child’s bones when they stand and move are different. These abnormal forces can cause the bones to “remodel” is a way that is not typical. These changes in the bone may become more noticeable as your child grows. To prevent deformities, equipment that supports posture and function may be recommended, from an early age, based on your child’s needs. Examples of equipment include orthotics, mobility aids such as a walker or crutches, standing frames, and wheelchairs with special seating,.

The muscles of young children are much larger compared to the size of their body than adolescents or adults. As they grow and gain weight, the force produced by the muscles does not increase as much as their size. This means that standing and walking may require more energy as children grow and become more difficult. For this reason, children should maintain a healthy body weight.